HEALTH INSURANCE MARKETPLACE: NOVEMBER ENROLLMENT REPORT

8/14/2019 HEALTH INSURANCE MARKETPLACE: NOVEMBER ENROLLMENT REPORT

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ASPE Issue Brief Page 2

ASPE Office of Health Policy November 2013

Marketplace plan selection of 106,185 is 1.5 percent of the estimated enrollees at the end of the 2014 openenrollment period (Congressional Budget Office (CBO) estimate, May 2013). (See Appendix C for moreinformation on enrollment experiences in other programs.)

Marketplace Website and Call Center Activity

Unique Visitors on the SBM and FFM websites: 26,876,527

Calls to the SBM and FFM call centers: 3,158,436

Overview of Enrollment to DateTo date, 106,185 persons have enrolled and selected a Marketplace planthis includes thosewho have paid a premium and those who have not yet paid a premium.

Based on available data, 846,184 completed applications were submitted to Marketplaces during

the first month of the initial open enrollment period (10-1-13 to 11-2-13), including applicationsthat were submitted to the SBMs and FFM. These completed applications correspond to a totalof 1,509,883 million individuals (persons) who have applied for coverage through theMarketplaces during this time period. This represents 22 percent of the Congressional BudgetOffice (CBO) estimated 7 million Marketplace enrollment in 2014. 2 (Please see Appendix A forcorresponding tables containing state-level data, and see Appendix B for methodologicalinformation on how these numbers were derived).

The Marketplaces have helped a total of 1,477,853 persons by determining or assessing 3 thatthey are either eligible to enroll in a Marketplace plan (used throughout this reportalso knownas Qualified Health Plans or QHPs) with or without financial assistance, or in Medicaid or the

Childrens Health Insurance Program (CHIP). To date, 106,185 persons have selected aMarketplace planthis includes 79,391 in SBMs and 26,794 in FFM. An additional 975,407 persons who have been determined eligible have not yet selected a plan through the Marketplace.

To date, the Marketplaces have processed eligibility determinations and assessments for 98 percent (1,477,853) of the 1,509,883 persons who have applied for coverage including:

1,081,592 persons (73 percent of the total number of persons with processed eligibilitydeterminations / assessments) have been determined eligible to enroll in a Marketplace

plan, (including 326,130 persons who have been determined eligible to enroll in aMarketplace plan with financial assistance),

o 106,185 (10 percent) of the 1,081,592 total Marketplace plan eligible personshave already selected a plan by clicking a button on the website page.

2 CBO estimates 7 million individuals will enroll in qualified health plans (QHPs) through the Marketplace in 2014.http://www.cbo.gov/sites/default/files/cbofiles/attachments/44190_EffectsAffordableCareActHealthInsuranceCoverage_2.pdf.3 Accounts of individuals who have been determined or assessed eligible for Medicaid or CHIP are transferred to state Medicaidand CHIP agencies, which then take any action needed to effectuate enrollment. Assessment refers to those FFM states wherethe state has chosen to retain the ability make the final eligibility determination.


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Enrollment includes those who have selected a plan including those who have paid their first month premium and those who have not yet done so.

396,261 persons (27 percent of the total number of persons with processed eligibilitydeterminations / as sessments) who have been determined or assessed eligible for

Medicaid or CHIP. 4

A total of 502,446, or 1 in 3 of the 1,477,853 people whose eligibility determinations /assessments have been processed, have either been determined or assessed eligible for Medicaidor CHIP or have selected a plan in the Marketplaces. Meanwhile, 722,391 (49 percent) of the1,477,853 whose eligibility determinations / assessments have been processed are either eligiblefor financial assistance through the Marketplaces, or have been determined or assessed eligiblefor Medicaid or CHIP.

An additional 201,137 persons who applied for coverage through the Marketplaces haveeligibility determinations that are either pending, not captured in the Marketplace plan and

Medicaid/CHIP eligibility counts for a given state, or negative (meaning that they have not beendetermined eligible to enroll in a Marketplace plan).

The available data on completed applications, eligibility determinations and assessments, andMarketplace plan selection represents a subset of the total number of Americans who have begunexploring the coverage options that are available through the new Marketplaces. There isconsiderable interest in the new Marketplaces as measured by unique visitors on the SBM andFFM websites (26,876,527), and calls to the SBM and FFM call centers (3,158,436).

These early enrollment-related statistics suggest that, in spite of recent information system andwebsite issues, inter est in the Marketplaces is high. For example a Commonwealth Fund survey

conducted Oct. 9-275

polled adults (ages 19-64) who are uninsured or have individual marketcoverage and found that most (60 percent) are aware of the Marketplace. Further, theCommonwealth Fund found that 53 percent are aware that financial support is available forMarketplace coverage and 17 percent have visited the Marketplace. Most (58 percent) said theyare very likely or somewhat likely to go or go back to visit the Marketplace to enroll in a plan orto apply for the premium tax credit or for Medicaid/CHIP before the open enrollment periodends on March 31, 2014. (See Appendix D for more information).

Marketplace enrollment is expected to increase as technical issues are resolved.

Enrollment Experience in Other Programs Based on the experience of the Federal Employees Health Benefits Program (FEHBP), MedicarePart D, Massachusetts Commonwealth Care, and the Childrens Health Insurance Program

4 Most FFMs assess individuals as eligible for Medicaid or CHIP, and the state Medicaid or CHIP agency takesadditional steps to finalize an eligibility determination. In states that accept the FFMs eligibility determination, thestate will take steps to effectuate enrollment.5 http://www.commonwealthfund.org/Publications/Data-Briefs/2013/Nov/Americans-Experiences-Marketplaces.aspx


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(CHIP), several factors drive enrollment rates, particularly in the early months of programoperation (See Appendix C):

Action-forcing events such as the end date of an open enrollment period or the startdate for benefits often result in a spike in enrollment activity.

The length of a programs pre-benefit period (i.e., the period between sign-up/enrollmentand the receipt of benefits) also affects rates of initial enrollment: Shorter pre-benefit

periods (e.g., 1 month) tend to generate higher initial enrollment rates than longer pre- benefit periods, during which the consumer may perceive little advantage to signing up orenrolling early.

Based on this experience, the Department expects Marketplace enrollment will start slowly, with peaks in December (as the January 1 coverage date approaches) and March (as the close of openenrollment approaches).

Based on available data for the first reporting period, the level of early Marketplace enrollmentappears to be consistent with expectations based on the Massachusetts Commonwealth Careexperience. Many of the SBMs have experienced first-month enrollment-related activity thatexceeds comparable Commonwealt h Care enrollment for the first month of open enrollment (SeeAppendix C for more information). 6

The SBMs experience to date regarding the type of eligibility determinations and assessmentsappear similar to Commonwealth Cares early months of enrollment as well. There were largedifferences in initial enrollment rates in Commonwealth Care between persons who qualified for

plans not requiring a premium payment and persons who did not qualify. Only about 4,000individuals signed up in the first couple months of the program for plans requiring a premium

payment. The majority of individuals who enrolled in Commonwealth Care during the first yearwere in plans that did not require the enrollee to pay a premium. Many of the SBMs haveexperienced first-month enrollment-related activity with substantial numbers of Medicaideligible individuals applying to the Marketplace. Enrollment of individuals anticipating paying a

premium for coverage is expected to increase as the start date for benefits, January 1, 2014,approaches.

Methodological OverviewThis report summarizes available data on enrollment-related activity during the first month of theinitial open enrollment period for the Marketplaces including the number of completedapplications, the number of processed eligibility determinations, and the number of completedMarketplace plan selections. The data that are reported in this issue brief have been generated bythe information systems of the Centers for Medicare & Medicaid Services (CMS), based oninformation reported to CMS by SBMs, and information collected by the FFM for states withHHS- supported or fully run Marketplaces (including those run in partnership with states).

6 Massachusetts auto-enrolled a large number of individuals from the states uncompensated care pool intoCommonwealth Care, a process which began October 1, 2006, before open enrollment became available to the

broader Commonwealth Care-eligible population on January 1, 2007. The population that was allowed to enrollstarting in January 2007 could qualify for premium subsidies based on income.


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Unless otherwise noted, the data in this issue brief represent cumulative Marketplace enrollment-related activity for the 10-1-13 to 11-2-13 reporting period, with information available as of 11-12-13. Data for certain metrics are not yet available for some states due to information systemissues. We anticipate that more comprehensive data will be available in future monthly

enrollment-related reports as system issues are resolved. (Please see Appendix B for additionalmethodological information and technical notes, including information about any limitations orclarifications regarding specific data points.)

We believe that the information contained in this issue brief provides the most systematicsnapshot of enrollment-related activity in the Marketplaces to date because the data for thevarious metrics are counted using comparable definitions for data elements across states, and

between the SBMs and FFM. It is important to note that the SBM enrollment-related datathat are reported in this issue brief represent state data that have been reported to CMS,and may differ from comparable data that have previously been publicly reported on SBMwebsites or in media reports because that data may be based on different time periods or

metric definitions from those used in this report.

Details on Marketplace Enrollment-Related Activity to DateThe following are highlights of enrollment-related activity in the Marketplaces during the firstmonth of the initial open enrollment period (see Appendix A for state-level data).

Completed Applications A total of 846,184 completed applications were submitted to theMarketplaces during the first month of the initial open enrollment period (10-1-13 to 11-2-13).This includes 326, 623 completed applications (39 percent of the combined SBM-FFM total) thatwere submitted to the SBMs, and 519,561 completed applications (61 percent of the combinedSBM-FFM total) that were submitted to the FFM. In addition to these applications, the FFM

also has 259,107 additional paper and call center applications that are not included in this total.

Based on currently available data, electronically-submitted (online) applications (includingapplications submitted through the Marketplace websites, as well as any applications that weresubmitted online through in-person assisters or the call center) accounted for approximately 74

percent of the completed applications that were submitted to the Marketplaces during thereporting period. The remainder of the completed applications (26 percent) were submitted on

paper (including applications that were submitted by mail, as well as any applications through in- person assisters or the call center that were filled out on paper). On average, approximately 93 percent of the completed applications that were submitted to the SBMs were submittedelectronically, and 67 percent of the completed applications that were submitted to the FFM were

submitted electronically. Number of Persons Applying for Coverage in Completed Applications The 846,184completed applications correspond to a total of 1,509,883 persons who have applied for coveragethrough the Marketplaces during this time period. The total number of persons applying forcoverage is higher than the total number of completed applications because each application can

potentially include multiple persons (such as spouses or dependents). A total of 516,248 persons(34 percent of the combined SBM-FFM total) have applied for coverage through the SBMs, and


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993,635 persons (66 percent of the combined SBM-FFM total) have applied for coveragethrough the FFM.

Number of Persons Determined or Assessed Eligible to Enroll in Coverage Through the Marketplace Overall, the Marketplaces have processed eligibility determinations for 98

percent (1,477,853) of the 1,509,883 total persons who have applied for coverage through theMarketplaces. Of these, 1,081,592 persons have been determined eligible to enroll in a planthrough the Marketplace, representing 72 percent of the total persons who have applied forcoverage through the Marketplaces as a whole, and 396,261 persons have been determined orassessed eligible for Medicaid or the Childrens Health Insurance Program (CHIP), representing26 percent of the total persons who have applied for coverage through the Marketplaces as awhole. Additionally, approximately 30 percent of the 1,081,592 total persons who have beendetermined eligible to enroll in a plan through the Marketplace have also been determinedeligible to enroll in a plan with financial assistance (326,130, representing 22 percent of the total

persons who have applied for coverage through the Marketplaces as a whole, and 22 percent ofthe total eligibility determinations / assessments that have been processed). The remaining

755,462 other Marketplace plan eligible persons includes individuals who: didnt apply forfinancial assistance; applied for financial assistance and were found ineligible; applied forfinancial assistance and their applications are pending.

Number of Persons Determined Eligible to Enroll in Coverage by the SBMs TheSBMs have processed eligibility determinations for 591,838 persons who have appliedfor coverage through the SBMs; however, this percentage varies by state due todifferences in processing times. Within the SBMs, 378,973 persons have beendetermined eligible to enroll in a Marketplace plan, and 212,865 persons have beendetermined eligible for Medicaid or CHIP using MAGI determination criteria.Additionally, approximately 23 percent (88,953) of the 378,973 total Marketplace plan

eligible persons in t he SBMs have also been determined eligible to enroll in a plan withfinancial assistance. 7

Number of Persons Determined or Assessed Eligible to Enroll in Coverage by the FFM The FFM has processed eligibility determinations for 89 percent (886,015) of the993,635 persons who have applied for coverage through the FFM. Within the FFM,702,619 persons have been determined eligible to enroll in a Marketplace plan(representing 71 percent of the total persons who have applied for coverage through theFFM), and 183,396 persons have been determined or assessed eligible for Medicaid orCHIP under MAGI determination criteria (representing 18 percent of the total personswho have applied for coverage through the FFM). Additionally, approximately 34

percent (237,177) of the 702,619 total Marketplace plan eligible persons in the FFM havealso been determined eligible to enroll in a plan with financial assistance 8 (alsorepresenting 24 percent of the total persons who have applied for coverage through the

7 SBM data on the number of persons with processed eligibility determinations or assessments do not add to the totalnumber of persons applying for coverage in completed applications due to missing data.8 Represents the total number of individuals determined to be eligible for plan enrollment through the Marketplace,who qualify for advance premium tax credits (APTC).


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FFM).

An additional 201,137 persons who applied for coverage through the Marketplaces (includingapproximately 93,245 in SBMs, and 107,892 in the FFM) have eligibility determinations in thePending/Other category, including those who: 1) have a pending eligibility determination or

assessment for a Marketplace plan or Medicaid/CHIP coverage; 2) have a processed eligibilitydetermination or assessment for a Marketplace plan or Medicaid/CHIP coverage that is notcaptured in the relevant column in this table for a given state due to system issues; or 3) have

been deemed ineligible for Marketplace coverage.

Number of Persons Who Have Selected a Marketplace plan Overall an estimated 106,185 (10 percent) of the persons who have been determined eligible to enroll in a plan through theMarketplace have already selected a plan (including both those who have paid the first months

premium and those who have not yet paid the first months premium). An additional 975,407 persons who have been determined eligible have not yet selected a plan through the Marketplace.

Number of Persons Who Have Selected a Marketplace plan in SBMs Within theSBMs, 79,391 (21 percent) of the persons who have been determined eligible to enroll ina plan through the Marketplace have already selected a plan through the SBM (including

both those who have paid the first months premium and those who have not yet paid thefirst months premium).

Number of Persons Who Have Selected a Marketplace plan in the FFM Within theFFM, overall 26,794 (4 percent) of the persons who have been determined eligible toenroll in a plan through the Marketplace have already selected a plan through the FFM(including both those who have paid the first months premium and those who have notyet paid the first months premium).

Highlights of Marketplace Customer Service and Outreach

Customer Service Based on available data, there have been a total of 26,876,527 uniquevisitors on the Marketplace websites, and a total of 3,158,436 calls to the SBM and FFMMarketplace call centers.

Customer Service (Website and Call Center Utilization) in SBMs Based on availabledata, there have been a total of 7,376,527 unique visitors on the SBM websites, and atotal of 923,170 calls to the SBM call centers.

Customer Service (Website and Call Center Utilization) in the FFM Based onavailable data, there have been a total of approximately 19,500,000 unique visitors on theFFM website, and a total of 2,235,266 calls to the FFM call center.

Outreach Several types of marketplace assisters help people navigate the new system. As of November 1, 2013, over 18,000 assisters have been trained in the states that are a part of theFederally-facilitated Marketplace. These assisters have informally reported that they haveconducted over 2,800 education and outreach events that have reached over 450,000 consumers


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in their states.

Maximizing Marketplace Enrollment: SBM Experiences

CA: California has conducted extensive public outreach efforts across the state, spending $94

million dollars to help community groups, local health clinics, and labor unions reach residentsand sign them up for coverage. California has used radio and television commercials, highway billboard advertisements, and a number of Twitter and Facebook posts to spread awareness ofCovered California throughout the state. To reach its Latino population, California hasestablished partnerships with Univision, Telemundo, La Opinion and impreMedia to implementSpanish-language media campaigns through TV, radio, print, and digital media. Outreachworkers who speak Spanish, Tagalog, Cambodian, Mandarin and Cantonese are attending localcommunity events such as county fairs, farmers markets, street festivals and back-to-schoolnights across the state.

KY: Kentucky reports tens of thousands of enrollees in its Marketplace, with high rates of

enrollment by young adults under 35 years old (40 percent) and women (59 percent). TheKentucky Health Benefit Exchange has awarded nearly $6.5 million in contracts to navigator programs throughout the state to ensure that Kentuckians have assisters to help them determinetheir health plan needs and assist them in choosing appropriate plans. The state also has 3,400certified insurance agents trained to explain the multiple offerings available.

NY: New York State of Health (NYSOH) Marketplace officials report that nearly 174,000 NewYorkers had completed the full application process and were determined eligible for coverage asof October 23, 2013. The fast pace of New Yorks enrollment uptake indicates that many NewYorkers are seeking affordable health coverage. NYSOHs customer service operators haveassisted more than 77,000 New Yorkers. Another potential factor in New Yorks success is thereduced rates in the individual market. NYSOH reports a 53 percent reduction compared to the

previous years rates.


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APPENDIX A

T OTAL M ARKETPLACE APPLICATIONS , ELIGIBILITY DETERMINATIONS , ANDM ARKETPLACE PLAN SELECTIONS BY M ARKETPLACE T YPE AND STATE , 10-1-2013

TO 11-2-2013

Total Marketplace Applications, Eligibility Determinations, andMarketplace Plan Selections By Marketplace Type and State (1)

10-1-2013 to 11-2-2013

State Name

TotalNumber ofCompleted

Applications(2)

TotalIndividuals

Applying forCoverage inCompleted

Applications(3)

Number of IndividualsDetermined Eligible toEnroll in a Marketplace

PlanDeterminedor AssessedEligible forMedicaid /

CHIP by theMarketplace

(6)

Pending/Other

(7)

Number ofIndividualsWho HaveSelected a

MarketplacePlan (8)

TotalEligible toEnroll in a

MarketplacePlan(4)

Eligible toEnroll in a

MarketplacePlan withFinancial

Assistance

(5)Number Number Number Number Number Number Number

States Implementing Their Own Marketplaces (SBMs)

California (9) 105,782 192,489 93,663 N/A 79,519 19,307 35,364

Colorado (10) 20,492 45,575 36,335 8,742 N/A 9,240 3,736

Connecticut 12,337 18,815 12,325 6,807 6,490 0 4,418District Of Columbia(11) 2,541 N/A N/A N/A N/A N/A N/A

Hawaii (12) 1,754 2,379 1,156 N/A N/A 1,223 N/A

Kentucky 50,279 76,294 39,207 13,201 28,676 8,411 5,586

Maryland 10,917 N/A 3,498 2,638 5,923 N/A 1,284

Massachusetts (13) 14,413 N/A N/A N/A N/A N/A N/A

Minnesota (14) 15,268 31,447 21,532 6,759 9,166 749 1,774

Nevada 9,186 14,819 N/A N/A 5,710 9,109 1,217

New York N/A N/A 134,897 34,267 23,902 N/A 16,404

Oregon (15) 8,752 N/A 190 N/A 425 N/A N/A

Rhode Island 6,670 9,581 3,326 2,086 3,447 2,808 1,192

Vermont 3,242 5,540 3,341 1,078 1,411 788 1,325

Washington (16) 64,990 119,309 29,503 13,375 48,196 41,610 7,091

SBM Subtotal 326,623 516,248 378,973 88,953 212,865 93,245 79,391

States With Marketplaces that are Supported by or Fully-Run by HHS (FFM) Idaho (17) 4,753 10,573 7,733 3,305 1,597 1,243 338New Mexico (17,18) 4,055 7,529 4,249 1,549 3,552 N/A 172Alabama 10,573 20,840 14,696 4,910 2,262 3,882 624Alaska 1,253 2,203 1,606 598 368 229 53Arizona 17,220 32,897 20,741 7,156 11,339 817 739Arkansas 7,294 14,059 6,123 2,279 7,430 506 250


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10-1-2013 to 11-2-2013

State Name


Applications(2)

TotalIndividuals


Applications(3)




(6)

Pending/Other

(7)


MarketplacePlan (8)


MarketplacePlan(4)



Assistance(5)

Number Number Number Number Number Number Number

Delaware 1,897 3,491 2,204 674 1,200 87 97Florida 67,366 123,870 93,456 29,637 12,887 17,527 3,571Georgia 28,642 56,783 41,426 12,757 7,709 7,648 1,390Illinois 30,901 56,636 35,802 11,603 19,447 1,387 1,370Indiana 15,982 31,979 19,093 7,890 11,305 1,581 701Iowa 5,547 10,884 6,104 2,079 4,490 290 136Kansas 6,061 12,205 9,087 3,009 1,718 1,400 371Louisiana 7,702 14,163 10,294 3,277 1,460 2,409 387Maine 3,550 6,497 5,061 2,116 623 813 271Michigan 23,987 44,025 34,197 12,468 4,978 4,850 1,329Mississippi 4,339 8,204 5,822 1,662 925 1,457 148Missouri 14,131 27,911 20,121 7,111 4,157 3,633 751Montana 2,683 5,205 3,815 1,711 457 933 212Nebraska 4,947 9,973 7,453 2,967 2,295 225 338

New Hampshire 4,006 7,817 5,767 2,016 1,643 407 269New Jersey 23,021 42,372 23,985 8,082 17,460 927 741North Carolina 29,547 57,653 42,110 15,051 7,404 8,139 1,662North Dakota 969 1,845 1,180 370 585 80 42Ohio 24,050 45,128 34,374 11,866 7,535 3,219 1,150Oklahoma 6,905 14,169 9,952 1,432 2,412 1,805 346Pennsylvania 31,827 57,674 43,966 15,497 3,788 9,920 2,207South Carolina 11,249 20,980 15,257 4,973 3,112 2,611 572South Dakota 1,491 3,081 2,279 822 525 277 58Tennessee 17,598 33,230 24,334 8,573 4,089 4,807 992Texas

53,904 108,410 80,960 25,520 11,682 15,768 2,991Utah 6,186 14,580 9,318 3,883 4,816 446 357Virginia 21,667 42,341 32,534 9,333 4,088 5,719 1,023West Virginia 3,807 7,096 3,442 1,268 3,103 551 174Wisconsin 19,098 34,678 22,038 8,911 10,736 1,904 877Wyoming 1,353 2,654 2,040 822 219 395 85

FFM Subtotal 519,561 993,635 702,619 237,177 183,396 107,892 26,794


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10-1-2013 to 11-2-2013

State Name


Applications(2)

TotalIndividuals


Applications(3)




(6)

Pending/Other

(7)


MarketplacePlan (8)


MarketplacePlan(4)



Assistance(5)

Number Number Number Number Number Number Number

MARKETPLACETOTAL, All States 846,184 1,509,883 1,081,592 326,130 396,261 201,137 106,185

Notes:

N/A means that the data for the respective metric is not yet available for a given state.(1) Unless otherwise noted, the data in this table represent cumulative Marketplace enrollment-related activity for10/1/13 to 11/2/13.(2) Completed Applications represents the total number of electronic and paper applications that were submittedto the Marketplace during the reference period with sufficient information to begin performing eligibilitydeterminations for enrollment in a plan through the Marketplace and, if the applicant applied for insuranceaffordability programs, sufficient information to begin performing eligibility determinations for advance

payments of the premium tax credit and cost-sharing reductions, as well as to begin eligibility assessments ordeterminations for Medicaid and CHIP. In the case of Medicaid and CHIP, the Marketplace may performeligibility assessments instead of determinations, at state option. Additionally, for electronic applications,Completed Applications include only those applications for which the applicant has hit the submit button andthe application has been accepted for further processing. In addition to these applications, the FFM also has259,107 additional paper and call center applications that are not included in this total. Note: a single CompletedApplication may include multiple individuals who are applying for coverage.(3) Individuals Applying for Coverage in Completed Applications represents the total number of individualsincluded in Completed Applications that were submitted to the Marketplace during the applicable reference

period. This number does not include individuals applying through the SHOP. Note: SBM data on the number ofIndividuals Determined Eligible to Enroll in a plan through the Marketplace and the number of IndividualsDetermined or Assessed Eligible for Medicaid / CHIP by the Marketplace do not add to the total number of

persons applying for coverage in completed applications due to missing data and differences in process flows forMarketplace Plans and Medicaid/CHIP eligibility determinations / assessments.(4) Individuals Determined Eligible to Enroll in a Plan Through the Marketplace (i.e., a Marketplace plan)represents the total number of individuals for whom a Completed Application has been received and who are

determined to be eligible for plan enrollment through the Marketplace during the reference period, whether or notthey qualify for advance payments of the premium tax credit or cost-sharing reductions. These individuals may ormay not have enrolled in coverage by the end of the reference period. Individuals who have been determined orassessed eligible for Medicaid or CHIP are not included.(5) Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with Financial Assistancerepresents the total number of individuals determined by the Marketplace to be eligible for enrollment through theMarketplace, who qualify for an advance premium tax credit (APTC). This number includes individuals who were


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determined eligible for Marketplace plan enrollment with only an APTC, as well as individuals who weredetermined eligible for enrollment into a plan with both an APTC and a cost-sharing reduction (CSR).(6) Individuals Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace represents the numberof individuals who have been determined or assessed by the Marketplace as eligible for Medicaid or CHIP, basedon modified adjusted gross income (MAGI). In some states, Completed Applications for individuals, whom theMarketplace has assessed as potentially eligible for Medicaid or CHIP, based on MAGI, are transferred to therelevant state agency for a final eligibility determination. In other states, the Marketplace has been delegated thefinal Medicaid/CHIP determination responsibility for these individuals. Thus, this data element includes allMedicaid MAGI assessments, regardless of the state Medicaid/CHIP agencys final eligibility determination.

Note: this data element does not include eligibility determinations made by State Medicaid/CHIP agencies basedon applications originally submitted to the State agency or other Medicaid/CHIP assessments or determinations.Additionally, this column may vary slightly from accounts transferred to states by the FFM.(7) Pending / Other: A derived estimate for individuals who have a completed and processed application, whoeither: 1) have a pending eligibility determination or assessment for Marketplace plan or Medicaid/CHIPcoverage; 2) have a completed eligibility determination or assessment for Marketplace plan or Medicaid/CHIPcoverage that is not captured in the relevant column in this table for a given state due to system issues; or 3) have

been deemed ineligible for Marketplace plan coverage.

(8) Individuals Who Have Selected a Marketplace plan represents the total number of Individuals DeterminedEligible to Enroll in a plan Through the Marketplace who have selected a plan (with or without the first premium payment having been received directly by the Marketplace or the issuer) during the reference period. This is alsoknown as pre-effectuated enrollment.(9) For California, the total includes individuals who have been fully determined as well as those that arepending and also those that are contingent.(10) Because the Colorado Marketplace does not have an eligibility system that is integrated with its stateMedicaid department, the data for Individuals Assessed Eligible for Medicaid/CHIP are not available at thistime.(11) The total of completed applications for the District of Columbia reflects online applications only. Data arecurrently not available for the District of Columbia on the number of individuals deemed eligible for or enrolledin Marketplace plan, or eligible or enrolled in Medicaid/CHIP because the District of Columbias informationsystems record data by accounts rather than number of individuals or covered lives. In many instances, theaccounts reflect two or more individuals. Thus, the District of Columbia has reported that between October 1,2013 and November 2, 2013, 572 plans were selected, which could represent 1,000 or more individuals selectinga plan.(12) Because the Hawaii Marketplace does not have an eligibility system that is integrated with its state Medicaiddepartment, the data for Individuals Assessed Eligible for Medicaid/CHIP are not available at this time.(13) Due to Massachusettss system constraints, cumulative values for Individuals Assessed Eligible forMedicaid/CHIP are not available at this time. Additionally, data for the total number of applications completedfor Massachusetts represents time period 10/01/13 through 11/01/13(14) Minnesota's cumulative data for Individuals Determined Eligible to Enroll in a Marketplace plan,Individuals Determined Eligible to Enroll in a Marketplace plan with Financial Assistance, and Individuals

Who Have Selected a Marketplace plan do not include adults between 133% and 200% of the Federal PovertyLevel (FPL) because these individuals are enrolled in the MinnesotaCare program. In addition, children up to275% FPL are covered through the Medicaid program. Please note that when comparing Minnesota's cumulativedata for these indicators with other State-Based Marketplaces, the number of individuals (2,505) determinedeligible for MinnesotaCare should be included in the calculation.(15) Cumulative data for Oregon represents best available data as of 11/04/13.(16) Cumulative data for Washington represents time period 10/01/13 through10/31/13. The total IndividualsDetermined or Assessed Eligible for Medicaid / CHIP may include some persons whose eligibility is being


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redetermined rather than newly determined. For example an application for a family may include parentsapplying to the Marketplace for initial coverage, while children are already covered.(17) Idaho and New Mexico are Federally supported SBMs for 2014; they are using the FFM platform for 2014.(18) New Mexico data on the number of Individuals Determined Eligible to Enroll in a Marketplace plan throughthe Marketplace and the number of Individuals Determined or Assessed Eligible for Medicaid / CHIP by the

Marketplace do not add to the total number of persons applying for coverage in completed applications due todifferences in process flow for Marketplace plan and Medicaid/CHIP eligibility determinations / assessments.Source: Centers for Medicare & Medicaid Services, as of 11-12-2013.


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APPENDIX B: M ETHODOLOGY AND T ECHNICAL NOTES

The data that are reported in this issue brief have been generated by the information systems ofthe Centers for Medicare & Medicaid Services, based on information reported to CMS by SBMs,and information collected by the FFM for states with HHS- supported or fully run Marketplaces(including those run in partnership with states).

Unless otherwise noted, the data in this issue brief represent cumulative Marketplace enrollment-related activity for the 10-1-13 to 11-2-13 reporting period, with information available as of 11-12-13. Data for certain metrics are not yet available for some states due to information systemissues. We anticipate that more comprehensive data will be available in future monthlyenrollment-related reports as system issues are resolved.

We believe that the information contained in this issue brief provides the most systematicsnapshot of enrollment-related activity in the Marketplaces to date because the data for thevarious metrics are counted using comparable definitions for data elements across states, and

between the SBMs and FFM (see table below). It is important to note that the SBMenrollment-related data that are reported in this issue brief represent state data that havebeen reported to CMS, and may differ from comparable data that have previously beenpublicly reported on SBM websites or in media reports because that data may be based ondifferent time periods or metric definitions from those used in this report.

Summary of Marketplace Monthly Enrollment-Related Information By Marketplace Type(10-1-13 to 11-2-13)

Marketplaces Total(SBMs and FFMs)

States ImplementingTheir Own

Marketplaces (SBMs)

States With Marketplacesthat are Supported by orFully-Run by HHS (FFM)

Number% of

Total* Number% of

Total* Number% of

Total*Completed Applications 846,184 n/a 326,623 n/a 519,561 n/a

Number of Individuals Applying for Coverage inCompleted Applications 1,509,883 100.0% 516,248 *** 993,635 100.0%

Number of Individuals With ProcessedEligibility Determinations or Assessments 1,477,853 97.9% 591,838 *** 886,015 89.2%

Eligible for Marketplace plan Enrollment 1,081,592 71.6% 378,973 *** 702,619 70.7%Eligible for Marketplace plan with APTC (non-add) 326,130 21.6% 88,953 *** 237,177 23.9%Other Marketplace plan-EligibleIndividuals (non-add) 755,462 50.0% 290,020 *** 465,442 46.8%

Determined or Assessed Eligible forMedicaid / CHIP by the Marketplace 396,261 26.2% 212,865 *** 183,396 18.5%

Pending / Other 201,137 ** 93,245 *** 107,892 10.9%

Total Individuals Eligible to Enroll in aMarketplace plan 1,081,592 100.0% 378,973 100.0% 702,619 100.0%

Marketplace Eligible Individuals Who HaveSelected a Marketplace plan 106,185 9.8% 79,391 20.9% 26,794 3.8%Marketplace plan Eligible Individuals WhoHave Not Yet Selected a Marketplace plan 975,407 90.2% 299,582 79.1% 675,825 96.2%

* Percent of total represents the percent of total individuals applying for coverage in completed applications, or the percent oftotal individuals eligible to enroll in a Marketplace plan who have selected a Marketplace plan.

** Pending/Other does not sum to 100 percent due to missing SBM data.


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*** Total SBM data on the number of persons with processed eligibility determinations or assessments do not add to the totalnumber of persons applying for coverage in completed applications due to missing data and differences in process flow forMarketplace plan and Medicaid/CHIP eligibility determinations / assessments.

Source: Centers for Medicare & Medicaid Services, as of 11-12-2013.

While this issue brief includes some data for all states, data for certain metrics are not availablefor certain states. For example, CMS did not receive data on the number of individuals applyingfor coverage in completed applications, the number of processed eligibility determinations andassessments, or the number of individuals eligible for plan enrollment through the Marketplacewho have selected a Marketplace plan from two states (Hawaii and Massachusetts) and theDistrict of Columbia.

In the table in Appendix A, which shows the state-level data, N/A means that the data for therespective metric is not yet available for a given state.

Definitions of Enrollment-Related Data Terms

Reference Period: Unless elsewhere noted, the reference period for which data arereported is from 10-1-13 to 11-2-13.

Oct 1- Nov 2 most closely represents the first month of operations since state basedMarketplaces generally compile enrollment-related metrics on a weekly basis.

Completed Applications: The total number of electronic and paper applications thatwere submitted to the Marketplace during the reference period with sufficientinformation to begin performing eligibility determinations for enrollment in a planthrough the Marketplace and, if the applicant applied for insurance affordability

programs, sufficient information to begin performing eligibility determinations for

advance payments of the premium tax credit and cost-sharing reductions, as well as to begin eligibility assessments or determinations for Medicaid and CHIP. In the case ofMedicaid and CHIP, the Marketplace may perform eligibility assessments instead ofdeterminations, at state option. Additionally, for electronic applications, CompletedApplications include only those applications for which the applicant has hit the submit

button and the application has been accepted for further processing. It is important tonote that a single Completed Application can include multiple individuals who areapplying for coverage.

These data represent completed applications that were reported as submitted across allchannels by the SBMs and FFM during the reporting period. Applications can be

submitted electronically (online) or on paper, by the applicant or on behalf of theapplicant by an assister (navigator, in-person assister, agent/broker), or through the callcenter. The data on paper applications that are included in this total are likely to beundercounted because of a lag time between mailing and receiving the applications.

Applications submitted through the mail are included in the paper category. Applicationssubmitted through the call center or in-person are included in the electronic or paper


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categories, as appropriate.

The FFM data on completed applications does not include paper applications or callcenter applications. An additional 259,107 applications were filed by paper and throughcall centers during this Oct. 1- Nov. 2 reporting period that are not included in this total.

Individuals Applying for Coverage in Completed Applications: The total number ofindividuals included in Completed Applications that were submitted to the Marketplaceduring the applicable reference period. This number does not include individualsapplying through the Small Business Health Options Program (SHOP).

Note: SBM data on the number of Individuals Determined Eligible to Enroll in a planthrough the Marketplace and the number of Individuals Determined or Assessed Eligiblefor Medicaid / CHIP by the Marketplace do not add to the total number of personsapplying for coverage in completed applications due to missing data.

Individuals Determined Eligible to Enroll in a Plan Through the Marketplace (i.e., aMarketplace plan) : The total number of individuals for whom a Completed Applicationhas been received and who are determined to be eligible for Marketplace plan enrollmentthrough the Marketplace during the reference period, whether or not they qualify foradvance payments of the premium tax credit or cost-sharing reductions. Theseindividuals may or may not have enrolled in a plan through the Marketplace by the end ofthe reference period. Individuals who have been determined or assessed as eligible forMedicaid or CHIP are not included.

Individuals Determined Eligible to Enroll in a Plan Through the Marketplace with

Financial Assistance: The total number of individuals determined by the Marketplace to be eligible for plan enrollment through the Marketplace, who qualify for advance premium tax credits (APTC). This number includes persons who were determinedeligible for plan enrollment with only APTC, as well as persons who were determinedeligible for enrollment into a Marketplace plan with both APTC and cost-sharingreductions (CSR).

This number does not include Marketplace plan eligible individuals who: didnt apply forfinancial assistance; applied for financial assistance and were found ineligible; or appliedfor financial assistance and their applications are pending.

Individuals Determined or Assessed Eligible for Medicaid/CHIP by theMarketplace: The number of individuals who have been determined or assessed by theMarketplace as eligible for Medicaid or CHIP, based on modified adjusted gross income(MAGI) eligibility criteria. In some states, Completed Applications for individuals,whom the Marketplace has assessed as potentially eligible for Medicaid or CHIP, basedon MAGI, are transferred to the relevant state agency for a final eligibility determination.In other states, the Marketplace has been delegated the final Medicaid/CHIPdetermination responsibility for these individuals. Thus, this data element includes all


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Medicaid/CHIP MAGI assessments by the Marketplace, regardless of the state agencysfinal eligibility determination. This data element does not include eligibilitydeterminations made by state Medicaid/CHIP agencies based on applications originallysubmitted to the state agency or other Medicaid/CHIP assessments or determinations.Additionally, this column may vary slightly from accounts transferred to states by the

FFM. Pending/Other: A derived estimate of the total number of individuals for whom a

Completed Application has been received, who either: 1) have a pending eligibilitydetermination or assessment for Marketplace plan or Medicaid/CHIP coverage; 2) have a

processed eligibility determination or assessment for Marketplace plan or Medicaid/CHIPcoverage that is not captured in the relevant column in this table for a given state due tosystem issues; or 3) have been deemed ineligible for Marketplace plan coverage.

The data represented in the Pending/Other column are only an approximation; becausethey are not strict subsets of one another, the sum of Individuals Eligible to Enroll in aMarketplace plan, Individuals Assessed Eligible for Medicaid/CHIP, andPending/Other does not necessarily equal the Total Individuals Applying for Coveragein Completed Applications. Given process flows, it is sometimes very difficult toseparate individuals who are assessed eligible for Medicaid [MAGI] and thosedetermined eligible for Marketplace plans.

Pending/Other does not sum to 100 percent of total Individuals Applying for Coverage inCompleted Applications due to missing SBM data.

Individuals Who Have Selected a Marketplace plan: The total number of IndividualsDetermined Eligible to Enroll in a Plan Through the Marketplace who have selected a

plan (with or without the first premium payment having been received directly by theMarketplace or the issuer) during the reference period, whether or not they are eligible toreceive an Advanced Premium Tax Credit or cost-sharing reduction.

Additional Technical Notes for SBM Data

For California, the total includes individuals who have been fully determined as well asthose that are pending and also those that are contingent.

Because the Colorado Marketplace does not have an eligibility system that is integratedwith its State Medicaid/CHIP agency, data for Individuals Assessed Eligible forMedicaid/CHIP are not available at this time.

The total of completed applications for the District of Columbia reflects onlineapplications only. Data are currently not available for the District of Columbia on thenumber of individuals deemed eligible for or enrolled in Marketplace plans, or eligible orenrolled in Medicaid/CHIP because the District of Columbias information systemsrecord data by accounts rather than number of individuals or covered lives. In manyinstances, the accounts reflect two or more individuals. Thus, the District of Columbiahas reported that between October 1, 2013 and November 2, 2013, 572 plans were


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selected, which could represent 1,000 or more individuals selecting a plan.

Because the Hawaii Marketplace does not have an eligibility system that is integratedwith its State Medicaid/CHIP agency, data for Individuals Assessed Eligible forMedicaid/CHIP are not available at this time.

Due to Massachusettss system constraints, cumulative values for Individuals AssessedEligible for Medicaid/CHIP are not available at this time; additionally, data for the totalnumber of applications completed for Massachusetts represents time period 10/01/13through 11/01/13.

Minnesota's cumulative data for Individuals Determined Eligible to Enroll in aMarketplace plan, Individuals Determined Eligible to Enroll in a Marketplace plan withFinancial Assistance, and Individuals Who Have Selected a Marketplace plan do notinclude adults between 133% and 200% of the Federal Poverty Level (FPL) becausethese individuals are enrolled in the MinnesotaCare program. In addition, children up to275% FPL are covered through the Medicaid program. Please note that when comparingMinnesota's cumulative data for these indicators with other State-Based Marketplaces,the number of individuals (2,505) determined eligible for MinnesotaCare should beincluded in the calculation.

Cumulative data for Oregon represents best available data as of 11/04/13. The totalIndividuals Determined or Assessed Eligible for Medicaid / CHIP may include some

persons whose eligibility is being redetermined rather than newly determined. Forexample an application for a family may include parents applying to the Marketplace forinitial coverage, while children are already covered.

Cumulative data for Washington represents time period 10/01/13 through10/31/13. Thetotal Individuals Determined or Assessed Eligible for Medicaid / CHIP may include some

persons whose eligibility is being redetermined rather than newly determined. Forexample an application for a family may include parents applying to the Marketplace forinitial coverage, while children are already covered.

Additional Technical Notes for FFM Data

For the data on eligibility: An individual found eligible with an inconsistency counts as an eligible person.

Counts for potentially eligible for Medicaid/CHIP include FFM Assessments as well as

FFM Determinations as directed by the states. The business logic for conducting Medicaid and CHIP eligibility assessments and

determinations are based on the FFMs interpretation of each states Medicaid and CHIPeligibility rules, and are subject to revision.

For the data on Marketplace plan selection: The Selection of a Marketplace plan metric reflects unique consumers who have


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enrolled in either a Marketplace plan or a Dental Plan. If a consumer selects both aMarketplace plan and a Dental Plan, they are counted as 1 plan selection. If a consumerenrolls in a Marketplace plan only, they are counted as 1 plan selection. If a consumerselects a Dental Plan only, they are counted as 1 plan selection. Any plan selection iscounted at the moment the consumer hits the Submit button in Plan Compare. These

are active polices. These data were pulled for an As of date of 11-2-2013, with the following logic:

If a policy is created in October and cancelled in October, that policy, and the individualson it, are NOT included in October counts.

If a policy is created in October and cancelled after November 2, 2013 that policy, andthe individuals on it, WOULD be included in October counts.

During an enrollment-related transaction, if a consumer clicks either the "Enroll" or the"Cancel" button more than once, the system may improperly generate multiple

transactions. In addition, duplicate transactions have been sent concerning the same person due to minor name differences. Until these technical issues are corrected, thenumber of transactions may underestimate or overestimate the number of people who willultimately be actively enrolled.

New Mexico data on the number of Individuals Determined Eligible to Enroll in a Marketplace plan through the Marketplace and the number of Individuals Determined or Assessed Eligible forMedicaid / CHIP by the Marketplace do not add to the total number of persons applying forcoverage in completed applications due to differences in process flow for Marketplace plan andMedicaid/CHIP eligibility determinations / assessments.


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APPENDIX C: P AST E XPERIENCES IN H EALTH C OVERAGE E NROLLMENT

Past enrollment experiences from other health coverage programs inform the Departmentsexpectations for enrollment in the new Marketplace. Based on the experience of the FederalEmployees Health Benefits Program (FEHB), Medicare Part D, Massachusetts Commonwealth

Care, and the Childrens Health Insurance Program (CHIP), we have learned that several factorsdrive enrollment rates, particularly in the early months of program operation.

1. Action-forcing events such as the end date of an open enrollment period or the startdate for benefits often result in a spike in enrollment activity.

2. The length of a programs pre-benefit period (i.e., the period between sign-up/enrollmentand the receipt of benefits) affects rates of initial enrollment. Shorter pre-benefit periods(e.g., 1 month) tend to generate higher initial enrollment rates than longer pre-benefit

periods, during which the consumer may perceive little advantage to signing up orenrolling early.

3. A requirement to pay the initial premium to complete enrollment creates a financialdisincentive to enroll early. Consumers are generally required to pay their first months

premium prior to the first day of coverage. This can result in last-minute enrollmentactivity by consumers to minimize the lag time between payment and access to benefits.Marketplace enrollees must pay premiums by December (even if they enroll in October)for coverage to begin January 1, this fact may affect enrollment in October and

November.

4. The use of auto or passive enrollment, where a group of consumers is enrolled in

coverage without any action on the consumers part, results in higher enrollment rates.5. Public education campaigns and outreach efforts tied to deadlines that correspond to

benefits coverage build consumer awareness and encourage enrollment.

Graphs included in this Appendix illustrate initial enrollment in Medicare Part D, MassachusettsCommonwealth Care, and CHIP, plus enrollment from the FEHBs annual open season for 2012.Each program differs in terms of pre-benefit periods, length of the open enrollment period, andthe use of auto-enrollment, which in turn affected enrollment rates during initial months ofoperation. For example, Medicare Part D experienced faster rates of enrollment compared toMassachusetts Commonwealth Care due to a six-month open enrollment period.


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Comparison of Early Part D and MassachusettsCommonwealth Care Enrollment Experience

0%

10%20%

30%

40%

50%

60%

70%

80%

90%

100%

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7

Medicare Part D Standalone PDP Beneficiary Elections (Excluding Autoenrolled)Massachusetts Commonwealth Care

Notes: Medicare Part D Standalone PDP (Prescription Drug Plan) Beneficiary Elections represents beneficiaries who submitted applications to enroll in aStandalone PDP (excluding Medicare/Medicaid full-benefit dual eligible beneficiaries who were initially autoenrolled into a PDP (including those whosubsequently switched plans) and including beneficiaries qualifying for the low income subsidy who received facilitated enrollment); Part D had a 6-month initialopen enrollment period. Massachusetts Commonwealth Care represents total enrolllees (including auto-enrolled individuals from the states uncompensatedcare pool; the program has continuous enrollment, allowing people to sign up at any time during the year.

Source: CMS and HHS Part D Enrollment Press Releases, 12/22/2005 6/14/2006; CMS Administrative Data (Facilitated Enrollments). Data on initialCommonwealth Care enrollment, available at http://www.mass.gov/chia/docs/r/pubs/09/key-indicators-02-09.pdf and

http://www.mass.gov/bb/h1/fy10h1/exec10/hbudbrief20.htm

InitialEnrollmentDuring FirstMonth AfterEnrollmentBegan

FacilitatedEnrollment ofNon-Full-BenefitDuals BeginsSurge Before

Beginning ofCoverage

Surge Before Endof Part D InitialEnrollment Period

Part D experienced faster rates of enrollment due to a six-month open enrollment period

P e r c e n

t o

f S t e a

d y - S

t a t e E n r o

l l m e n

t

ContinuousEnrollment


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Massachusetts Commonwealth Care. Commonwealth Care is a means-tested subsidizedinsurance program for uninsured individuals who do not qualify for Medicaid (MassHealth) andis part of the Massachusetts Health Connector. Enrollment and benefits for subsidized coveragein Commonwealth Care began January 1, 2007, although Massachusetts auto-enrolled a largenumber of individuals from the states uncompensated care pool beginning October 1, 2006.

Comm onwealth Care enrollment appears to have reached a steady state a year after coverage began. 9 By December 2007, 158,000 people had enrolled in Commonwealth Care.

The majority of individuals who enrolled in Commonwealth Care during the first year were inType I plans and not responsible for paying a premium. There were large differences in initial

enrollment rates between those who qualified for plans without having to pay a premium andthose who were required to pay a premium (see chart below). 10 For the plan types that mayrequire a premium payment (Type II, III and IV), only about 4,000 individuals signed up in thefirst couple of months of the program.

9 For data on initial Commonwealth Care enrollment, see http://www.mass.gov/chia/docs/r/pubs/09/key-indicators-02-09.pdf and http://www.mass.gov/bb/h1/fy10h1/exec10/hbudbrief20.htm10 Individuals who have Commonwealth Care Plan Type I (available to those with incomes below 100 percent of theFPL) do not pay premiums for coverage. Individuals who have incomes above 150 percent of the FPL and areenrolled in Plan Type II-IV (available to those with incomes 100.1 to 300 percent of the FPL) pay premiums unlesstheir income is below 150 percent FPL. Data on enrollment by plan type through May 2007 are available here:https://www.mahealthconnector.info/portal/binary/com.epicentric.contentmanagement.servlet.ContentDeliveryServlet/About%252520Us/Publications%252520and%252520Reports/2007/2007-05-10/CommCare%252520Program%252520Update.pdf


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Massachusetts Commonwealth Care Enrollment by Plan Type, 2006-2007

Source: Boston Globe, October 16, 2013:http://www.boston.com/lifestyle/health/health_stew/2013/10/how_much_aca_enrollment_is_enough.html

Federal Employees Health Benefits Program. The Office of Personnel Management reportsthat enrollment spikes in the last few days before the end of the open enrollment period. This isconsistent with the experience of private employers as well. The FEHB program has an annual,month-long open season during which employees are allowed to change their insurance coveragestatus and switch plans. Data from the FEHBs 2012 open season shows that relatively fewemployees make changes to their coverage in the first couple weeks of the period. Nearly a

quarter (22 percent) of those employees who changed their enrollment during the open seasonmade their selection in the last two days before the seasons deadline. In the table below, Week 5of 2012 open season consisted of only 2 days.

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

N o v . 2 0 0 6

D e c . 2 0 0 6

J a n

. 2 0 0 7

F e b

. 2 0 0 7

M a r . 2 0 0 7

A p r . 2 0 0 7

M a y 2 0 0 7

J u n

. 2 0 0 7

J u l . 2 0 0 7

A u g . 2 0 0 7

S e p t . 2 0 0 7

O c t . 2 0 0 7

N o v . 2 0 0 7

D e c . 2 0 0 7

Plan Type I (No Premium)

Plan Type II-IV (Premium)

Total


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*Week 5 comprises only 2 daysSource: Office of Personnel Management

Medicare Part D. Initial enrollment for Part D opened November 15, 2005 and closed on May15, 2006. Coverage began January 1, 2006, approximately six weeks after the start of openenrollment. The enrollment rate was 15 percent at the end of December 2005, the end of thepre-benefit period, and rose to 98 percent by May 2006, the end of the open enrollment period.This data (and graph) includes only those who affirmatively enrolled and paid a premium for astandalone Medicare Part D plan . Medicare Part D had auto-enrollment for Medicare-Medicaiddual eligibles and those in Medicare Advantage plans that added drug coverage, but we do notinclude those enrollees in the chart below.


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Source: Centers for Medicare & Medicaid Services

Childrens Health Insurance Program. CHIP experienced low enrollment rates in the earlyyears of the program. Despite extensive outreach and streamlining of application procedures,only 60 percent of eligible children participated in CHIP fully five years after states beganimplementing their CHIP programs in 1998. At that point the program reached an enrollment

plateau. Currently, CHIP, combined with Medicaid, reaches 86 percent of all eligible children.

Source: Centers for Medicare & Medicaid Services


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Expectations for Marketplace EnrollmentLooking forward, the Department expects that Marketplace enrollment will start slowly, with

peaks in December 2013 (shortly before benefits begin January 1) and March 2014 (at the end ofopen enrollment). There is a three-month lag between the beginning of open enrollment onOctober 1, 2013, and January 1, 2014 when Marketplace benefits begin. As a result, the

Department anticipates the enrollment trend will start gradually, with low enrollment in the firsttwo months of open enrollment (October 2013 and November 2013). Enrollment activity isexpected to increase in December in anticipation of coverage starting January 1, 2014 and againin March as the March 31, 2014 deadline for open enrollment approaches .


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APPENDIX D: C ONSUMER AWARENESS OF THE M ARKETPLACE

National surveys show that awareness of the Marketplaces increased over the month of October,and nearly one in five Americans who is uninsured or covered by individual market insurancehas visited the Marketplace to shop for a plan.

A Commonwealth Fund survey conducted Oct. 9-27 11 polled adults (ages 19-64) who areuninsured or have individual coverage and found:

Most (60 percent) are aware of the Marketplace.o 53 percent are aware that financial support is available for Marketplace coverage.o 17 percent have visited the Marketplace.

Most (58 percent) said they are very likely or somewhat likely to go or go back to visitthe Marketplace before the end of open enrollment on March 31, 2014 to enroll in a planor to apply for a premium tax credit or for Medicaid.

Of those who have visited the Marketplace, 21 percent enrolled in a plan.o 47 percent tried to find out if they were eligible for financial assistance (through

APTCs or CSRs) or Medicaid.o 27 percent rated their Marketplace experience excellent or good, and 70 percent

said it was fair or poor.o 56 percent said it was difficult, very difficult, or impossible to find a plan with the

type of coverage they needed; 38 percent said it was somewhat easy or very easy.

Of those who did not enroll in October, the most frequently cited reasons were: not beingcertain they could afford a plan (48 percent), still trying to decide on a plan (46 percent),and thinking deductibles and copayments were too high (42 percent).

The polling firm Gallup found in its October surveys: Among all uninsured adults, 18 percent have visited or attempted to visit the online

Marketplace. Among uninsured adults who are planning to obtain or who have alreadyobtained coverage throu gh the Marketplace, 22 percent have visited or attempted to visitthe online Marketplace. 12

The share of the uninsured who consider themselves familiar with the Marketplace waslarger at the end of October (27 percent) than at the end of September (25 percent). 13

According to a national survey by the Pew Research Center, conducted Oct. 9-13, 14 awarenessof the Marketplaces is higher in states that are involved in running their Marketplaces:

11 http://www.commonwealthfund.org/Publications/Data-Briefs/2013/Nov/Americans-Experiences-Marketplaces.aspx12 Poll conducted Oct. 23- Nov. 6. http://www.gallup.com/poll/165776/uninsured-americans-ignoring-health-exchange-sites.aspx13 The October poll was conducted Oct. 18-29, 2013. http://www.gallup.com/poll/165668/uninsured-aware-health-insurance-requirement.aspx14 http://www.people-press.org/2013/10/21/public-registers-bumpy-launch-of-health-care-exchange-websites/


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In the 24 states (including D.C.) with State-based Marketplaces or state-federalPartnership Marketplaces, 72 percent are aware that a Marketplace is available.

In the 27 states that have federally-run Marketplaces, 59 percent are aware that aMarketplace is available in their state.

Documents

HEALTH INSURANCE MARKETPLACE: NOVEMBER ENROLLMENT REPORT